Qualitative Alpha-defensin Versus The Main Available Tests For The Diagnosis Of Periprosthetic Joint Infection: Best Predictor Test?

Introduction: Biomarkers such as \u3b1-defensin demonstrated to be a potentially useful option in periprosthetic joint infection (PJI) diagnosis. Recently, a new point-of-care test for \u3b1-defensin level detection in synovial fluid has been commercialized in Europe. The aim of this study is to compare the \u3b1-defensin test (SynovasureTM) diagnostic ability with the main available clinical tests for periprosthetic joint infection diagnosis in a practical clinical setting of a Bone Infection Unit. Methods: Between 2015 and 2017, 146 patients with suspected chronic PJI were screened with SynovasureTM. Seventy-three of these met the Musculoskeletal Infection Society (MSIS) criteria and were included in the analysis. According to MSIS criteria, 40 patients (54.7%) were classified as infected and 33 (45.3%) as not infected. The results obtained with SynovasureTM were recorded and compared with standard diagnostic methods for PJI diagnosis. Results: SynovasureTM showed a sensitivity of 85.0 % (95% CI 70.2 to 94.3) and a specificity of 96.9 % (95% CI 83.8 to 99.9) for PJI detection. The positive likelihood ratio of SynovasureTM was 27.2 (95% CI 3.9 to 188.1) and the negative likelihood ratio was 0.2 (95% CI 0.1 to 0.3). The diagnostic odds ratio was 181.3 (95% CI 20.7 to 1590.4). SynovasureTM demonstrated a statistical significant difference when compared to Erythrocyte Sedimentation Rate (ESR) and C-reactive Protein (CRP) specificity (at least one positive test) and preoperative culture sensitivity (1 positive culture). Conclusion: Our findings show that SynovasureTM sensitivity is lower than quantitative \u3b1-D test, but when compared to the main available tests shows a good specificity and the highest DOR. On the SF it is the easier test to do, due to the fact that it needs a minimal amount of SF and it is not limited by blood contamination or antibiotic use. Whereas there is no single standalone test, SynovasureTM should be considered a reliable additional test for periprosthetic joint infection diagnosis in everyday clinical practice

Arthroscopic Lateral Retinacular Release and Modified Goldthwait Technique for Patellar Instability

Surgical options for patellofemoral (PF) disorders include proximal or distal realignment, cartilage restoration techniques, open or arthroscopic lateral retinacular release, and medial soft-tissue reefing. Skeletal immaturity and donor- site morbidity can be of concern in most reconstructive procedures. The Goldthwait procedure with hemi-patellar transfer and medialization combined with arthroscopic lateral retinacular release results in medialization of the PF contact point in flexion and corrects maltracking to prevent recurrent patellar dislocation. This functional procedure is indicated for PF instability and has historically been used in children to accommodate the immaturity of the tibial tubercle and physis. The purpose of surgical correction is to improve PF tracking, reducing the lateralizing forces on the patella with the correction of the Q angle (angle between the quadriceps tendon and patellar tendon). The purpose of this Technical Note was to describe, in detail, arthroscopic lateral retinacular release combined with the modified Goldthwait procedure for recurrent patellar instability

Effectiveness of corticosteroid injections in Civinini-Morton's Syndrome: A systematic review

BACKGROUND: The aim of this paper is to analyze the effectiveness of corticosteroid injections (CI), in combination with or without a local anaesthetic, for Civinini-Morton's Syndrome to determine which protocol could be the most appropriate among conservative treatments.METHODS: All selected articles were screened using a thorough database search of PubMed, EMBASE and SCOPUS to assess their suitability to the research focus.RESULTS: Selection produced 10 articles as full-text, for a total of 590 patients, with a mean follow-up of 14 \ub1 14.2 (range 3-48) months. Johnson satisfaction scale, resulting from 6 studies, scored 25.6% (range 5-38) and 39.4% (range 15-51.8), respectively completely satisfied and satisfied with minor reservations. Mean VAS, declared in 5 studies, decreased from 70.7 \ub1 16.5 (range 67-89) to 33.4 \ub1 7.6 (26-42.5) points (p < 0.01). Most common complication was skin depigmentation in 7 (2.6%) cases.CONCLUSIONS: CI appear to be a safe treatment allowing good results with a very low complications rate. A neuroma of 6.3 mm seems to be the cut-off size; below which CI could have best indications and be considered as an intermediate treatment between shoe modifications and more invasive procedures such as percutaneous alcoholization or surgery.LEVEL OF EVIDENCE: Level II, systematic review

CTLA4-Ig interacts with cultured synovial macrophages from rheumatoid arthritis patients and downregulates cytokine production

Introduction: Co-stimulatory signal B7(CD80/CD86):CD28 is needed in order to activate T cells in immune response. Cytotoxic T lymphocyte-associated antigen-4-immunoglobulin (CTLA4-Ig) binding to the B7 molecules on antigen-presenting cells downregulates this activation and represents a recent biological treatment in rheumatoid arthritis (RA). Objectives of the study were to investigate the presence of the B7.2 (CD86) molecule and its masking by CTLA4-Ig on cultures of both RA synovial macrophages (RA SM), and of macrophages differentiated from THP-1 cells (M). In addition, the anti-inflammatory effects of CTLA4-Ig on co-cultures of RA SM and M with activated T cells were tested.Methods: All macrophages were co-cultured for 24 hours with activated T cells, without or with CTLA4-Ig (10, 100, 500 \u3bcg/ml for 1 hour, 3 hours and overnight, respectively). Immunofluorescence (IF) staining for B7.2, and an analysis of inflammatory cytokine expression (interleukin (IL) -6, tumor necrosis factor (TNF) \u3b1, IL-1\u3b2, transforming growth factor (TGF) \u3b2) by immunocytochemistry (ICC), western blot (WB) and reverse transcriptase-polymerase chain reaction (RT-PCR) were performed.Results: Macrophages showed intense B7.2 expression. CTLA4-Ig/B7.2 masking was evident for all macrophages, even after only 1 hour of cell culture (range from 10 to 100 \u3bcg/ml). ICC of co-cultures showed a dose-dependent decrease in inflammatory cytokines (P < 0.001 for IL-6, TNF\u3b1, IL-1\u3b2 and TGF\u3b2). Data were confirmed by WB and RT-PCR analysis.Conclusions: Optimal concentrations of CTLA4-Ig for the CTLA4-Ig/B7.2 masking on activated macrophages were identified and were found to induce significant downregulation in the cell production of IL-6, TNF\u3b1, IL1-\u3b2 and TGF\u3b2. In conclusion, macrophages would appear to be a sensitive target for CTLA4-Ig treatment in RA

What is the Current Evidence on Vertebral Body Osteonecrosis?: A Systematic Review of the Literature

Osteonecrosis (ON) is a clinical entity characterized by a pattern of cell death and complex process of bone resorption and formation. Studies related to ON have largely focused on certain anatomical sites; however, the evidence on vertebral body ON (VBON) is largely inconsistent and fragmented. The aim of this study was to clarify the pathophysiology, risk factors, imaging findings, and available treatment modalities for VBON. A systematic review of the relevant articles published in English was performed using PubMed, Embase, Medline, Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL databases. A total of 81 articles were included in this study. Three main topics about VBON were identified: (1) pathophysiology and risk factors, (2) diagnosis, and (3) treatment. Forty-five studies were based on the pathophysiology, 52 on diagnosis, and 38 on the treatment options for VBON. The literature on VBON was limited and mainly focused on post-traumatic cases with a considerable overlap with nonunion and pseudoarthrosis

Arachnoiditis ossificans, isthmic spondylolisthesis and pseudomeningocele. A rare clinical scenario

The combination of arachnoiditis ossificans, isthmic spondylolisthesis and calcific pseudomeningocele is an extremely unusual condition. In the current literature, there is no previous report of this intricate clinical scenario, and therefore there are no clear indications on the best treatment. In the reported surgical case, the excision of calcific pseudomeningocele, L4 bilateral laminectomy and foraminotomy and posterolateral fusion were performed. L4L5 interbody fusion was aborted for impossibility of neural elements mobilization and a consequent intraoperative dural tear. The aims of the adopted surgical procedure are the decompression of neural elements and the stability due to bone fusion

Analysis of gene expression on anodic porous alumina microarrays

This paper investigates the application of anodic porous alumina as an advancement on chip laboratory for gene expressions. The surface was prepared by a suitable electrolytic process to obtain a regular distribution of deep micrometric holes and printed by pen robot tips under standard conditions. The gene expression within the Nucleic Acid Programmable Protein Array (NAPPA) is realized in a confined environment of 16 spots, containing circular DNA plasmids expressed using rabbit reticulocyte lysate. Authors demonstrated the usefulness of APA in withholding the protein expression by detecting with a CC D microscope the photoluminescence signal emitted from the complex secondary antibody anchored to Cy3 and confined in the pores. Friction experiments proved the mechanical resistance under external stresses by the robot tip pens printing. So far, no attempts have been made to directly compare APA with any other surface/substrate; the rationale for pursuing APA as a potential surface coating is that it provides advantages over the simple functionalization of a glass slide, overcoming concerns about printing and its ability to generate viable arrays. \ua9 2013 Landes Bioscience

Arthroscopic treatment of symptomatic bipartite patella.

Successful arthroscopic treatment of symptomatic bipartite patella in a 23-year-old female professional volleyball player is reported

Rotula bipartita: trattamento artroscopico in atleta professionista

La rotula bipartita rappresenta una patologia non frequente, con una incidenza tra lo 0,2% ed il 6% nella popolazione adulta. Il suo riscontro avviene spesso in occasione di accertamenti radiografici per un generico trauma al ginocchio. \uc8 solitamente asintomatica e solo in una percentuale inferiore al 2% diventa sintomatica. Descriviamo un caso di rotula bipartita sintomatica in una giovane praticante attivit\ue0 sportiva agonistica, evidenziando i vantaggi del trattamento artroscopico in caso di bipartitismo sintomatico non responsivo al trattamento conservativ